Intended for healthcare professionals

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Ready, steady . . . go?

BMJ 2020; 368 doi: (Published 12 March 2020) Cite this as: BMJ 2020;368:m984

Read our latest coverage of the coronavirus outbreak

  1. Rebecca Coombes, head of news and views
  1. The BMJ
  1. rcoombes{at}
    Follow Rebecca on Twitter @rebeccacoombes

As the gravity of the covid-19 outbreak unfolds, it’s clear that this crisis requires a balanced approach that tells people what they and the health system can do without causing panic.

This week The BMJ publishes a guide for GPs on managing patients with covid-19, pulling together guidance from Public Health England and Health Protection Scotland (doi:10.1136/bmj.m800). It covers identifying potential new cases, how to correctly isolate patients to prevent onward transmission, and referring severely unwell patients safely to hospital. The visual summary it includes is particularly useful.

But even if health professionals know the drill, are they being equipped to do their job safely? Helen Salisbury speaks for many GPs in admitting that she isn’t ready for a pandemic (doi:10.1136/bmj.m944). She says, “We haven’t received our personal protective equipment at our practice or any training in how to use it. We haven’t yet worked out whether, or how, to stop people with respiratory symptoms and fever from walking into our surgery.” She also voices a growing concern that the current criteria for triage are too narrow because they are based on travel or contact with travellers. “As not all reported cases fit this profile, we worry it won’t be enough to keep covid-19 out of our surgery.”

Salisbury also sensibly cautions against dragging patients with long term conditions into surgeries for QOF driven routine checks. “We won’t be prioritising tick boxes this month, and so this year’s QOF should be delayed or abandoned while we focus on more pressing clinical work.”

Elsewhere we pool some answers from experts to questions such as how you can protect yourself if you haven’t been fit tested for the correct masks (doi:10.1136/bmj.m978). The short answer is that your employer has a legal obligation to protect you from harm, and the GMC places doctors under no ethical duty to put themselves at risk.

If avoiding public transport seems a sensible precaution to avoid infection, then now is perhaps a good time to get on your bike. A research study this week (doi:10.1136/bmj.m336) finds that cyclists, when compared with all other commuters, show a reduced risk of cardiovascular disease (by 21%), lower risk of first cancer diagnosis (11%), and lower risk of death (12%). Cycling to work is associated with a higher risk of admission to hospital because of injury, but if you have safe cycling routes nearby what are you waiting for?

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